超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜下胃癌根治术后镇痛中的应用

Application of ultrasound-guided transversus abdominis plane block combined with abdominal rectus sheath block for postoperative analgesia in patients undergoing laparoscopic radical gastrectomy for ganstric cancer

目的探讨腹腔镜下胃癌根治术后镇痛中,超声引导下腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)的应用效果。方法选择行腹腔镜下胃癌根治术中患者40例,随机分为两组,试验组20例,采用TAPB联合RSB镇痛;对照组20例,采用TAPB镇痛。对比两组镇痛效果。结果拔管后10min与术后4h,试验组心率和平均动脉压均低于对照组(P<0.05)。试验组出麻醉后监测治疗室(PACU)时刻、术后4h、12h、24h视觉模拟评分(VAS)均低于对照组(P<0.05)。试验组术后镇痛泵按压次数、手术后恶心呕吐(PONV)及嗜睡发生率均明显低于对照组(P<0.05)。结论腹腔镜下胃癌根治术的镇痛中,采用超声引导下TAPB联合RSB定位准确,安全性好,可获得良好的镇痛效果。

Objective To investigate the effects of ultrasound-guided transversus abdominis plane block(TAPB)combined with abdominal rectus sheath block(RSB)for postoperative analgesia in patients undergoing laparoscopic radical gastrectomy for ganstric cancer.Methods Forty patients undergoing laparoscopic radical gastrectomy for gastric cancer were selected and randomly divided into two groups,the ultrasound-guided TAPB combined with RSB analgesia was implemented for 20 patients in the experimental group,and TAPB analgesia was implemented for 20 patients in the control group.The analgesic effects on patients in two groups were compared.Results The heart rate(HR)and mean arterial pressure(MAP)of patients in the experimental group is lower than the control group in 10 minutes after extubation and 4 hours after operations(P<0.05).The visual analogue scale(VAS)of patients in the experimental group at the time of post-anesthesia care unit(PACU),4 h,12 hand 24 h after operations were lower than such index of patients in the control group(P<0.05).The post-operative analgesia pump pressing times and the incidence of postoperative nausea and vomiting(PONV)and somnolence of patients in the experimental group were significantly lower than such indexes of patients in the control group(P<0.05).Conclusion Ultrasound-guided transversus abdominis plane block combined with abdominal rectus sheath block is an accurately positioned and safe technique for postoperative analgesia after laparoscopic radical gastrectomy for gastric cancer,delivering great analgesic effect.